COMMENTARY

Surgery Is Unlikely to Improve Functional Status in Many Older Patients

Albert B. Lowenfels, MD

Disclosures

January 31, 2019

What impact does surgery have on the functional status of an older patient? The aim of a recent study, published in Annals of Surgery,[1] was to assess recovery of function after elective and nonelective surgery in a group of elderly patients (N= 250; average age, 82 years) in relation to four preoperative disability groups: none, mild, moderate, and severe.

Postoperative functional recovery was classified as rapid, gradual, partial, or little improvement over a period of 12 months. Postoperative mortality increased with a decrease in preoperative function. (P = .001). Rapid postoperative improvement was limited to patients with no or mild preoperative functional disability. In contrast, most patients with severe preoperative disability showed no improvement in functional status.

Functional Prognosis Is Highly Dependent on Pre-op Status

In this study by Stabenau and colleagues, preoperative function was based on items such as the ability to perform tasks important for daily life (ie, getting dressed, going shopping, taking medications, walking a quarter of a mile, and climbing a flight of stairs). These traits were tightly linked to postoperative recovery pathways.

Surgeons already know intuitively that recovery in frail elderly patients can be slow and that their preoperative status is a predictor of what to expect postoperatively. This study is unusual in that there is limited quantitative information linking a patient's functional ability prior to surgery with anticipated functional ability after surgery.

The information on preoperative function provided in this report can help guide preoperative discussions about what might be expected following an operation. It also supports the concept of a team approach to managing pre- and postoperative care for elderly patients. It is discouraging but realistic to know that for many elderly patients, surgery is unlikely to improve their functional status.

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